ACP offers guidance on the ethical use of genetic testing and precision medicine – EurekAlert

1. ACP offers guidance on the ethical use of genetic testing and precision medicine

Abstract: https://www.acpjournals.org/doi/10.7326/M22-0743

URLs go live when the embargo lifts

A new position paper from the American College of Physicians (ACP) offers guidance regarding ethical decision-making for the integration of precision medicine and genetic testing into internal medicine. ACP's advice is published in Annals of Internal Medicine.

The paper was developed by ACPs Ethics, Professionalism and Human Rights Committee in response to the issue of rapid advances in genome sequencing technology that have generated a range of genetic testing technologies that can contribute to precision medicine. Like many new technologies, these testing approaches have the potential to improve health care but can pose ethical questions. The position paper states that:

The position paper is intended to complement and provide more specificity to the guidance outlined in the ACP Ethics Manual, which identifies a number of issues associated with precision medicine including the broad implications of genetic testing including for family members, incidental findings, education for physicians and patients, counseling needs, privacy and confidentiality concerns, costs and possible consequences such as the discovery of unwanted information or discrimination. Precision medicine, defined as individualized care based on knowledge of a persons genetics, lifestyle, and environment, encompasses a wide spectrum of uses of genetic information including predictive risk testing, risk assessment, diagnostic testing, pharmacogenomics, molecular profiling of tumors, population screening, and direct-to-consumer genetic testing.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with someone from ACP, please contact Andrew Hachadorian at ahachadorian@acponline.org.

-------------------------------------------------

2. Atrial fibrillation after non-cardiac surgery is common and not benign

Abstract: https://www.acpjournals.org/doi/10.7326/M22-0434

URLs go live when the embargo lifts

A cohort study of persons with incident atrial fibrillation (AF) has found that AF after noncardiac surgery is common and comprises 13 percent of all new AF diagnoses. Postoperative AF is also associated with similar risk for stroke or transient ischemic attack (TIA) and death as AF unrelated to surgery. The findings are published in Annals of Internal Medicine.

AF occurring after noncardiac surgery may be triggered by perioperative stress and systemic inflammation in patients with predisposing comorbidities. For those who develop AF within 30 days of surgery, AF often recurs during subsequent follow-up and carries increased risks for thromboembolism and death compared with patients who had surgery but did not develop AF. It is less clear how postoperative AF compares with AF occurring outside of the operative setting for risk of both nonfatal and fatal outcomes.

Researchers from the Mayo Clinics Departments of Cardiovascular Medicine and Quantitative Health Sciences studied data from the Rochester Epidemiology Project (REP) for 4,231 patients with incident AF to compare the risks for ischemic stroke or TIA and other outcomes in patients with postoperative AF versus those with incident AF not associated with surgery. They found that 550 patients, or 13%, had postoperative AF as their first-ever documented AF presentation. Most of these incidents occurred within one week after surgery and the cumulative incidence of subsequent documented AF was approximately 21% at 1 year after the index periprocedural AF episode. The authors also found that compared to AF unrelated to a surgical procedure, postoperative AF was associated with similar risks for stroke or TIA and death. According to the authors, their results suggest that patients with postoperative AF may require ongoing surveillance for the arrhythmia and its complications. They also suggest that the underuse of anticoagulation in these patients may reflect the perception that postoperative AF is an isolated, provoked arrhythmia after noncardiac surgery that carries less severe implications than other forms of AF, but their data show that this perception may be erroneous and underscores a therapeutic gap with direct clinical relevance.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Alanna M. Chamberlain, PhD, or the first author, Konstantinos C. Siontis, MD, please contact Teresa Malloy at malloy.teresa@mayo.edu.

-------------------------------------------------

3. Telehealth-delivered maternal care yields similar results to in-person visits

Abstract: https://www.acpjournals.org/doi/10.7326/M22-0737

URL goes live when the embargo lifts

A rapid systematic review of published research found that when telehealth-delivered care was used to supplement or replace in-person maternal care services, clinical outcomes and patient satisfaction were similar, and sometimes better, compared to in-person care. The findings are published in Annals of Internal Medicine.

Access to high-quality maternal health care is associated with reduced maternal morbidity and mortality

because it facilitates identification of conditions that increase the risk for poor outcomes and enables timely prevention or treatment. Maternal morbidity and mortality are unacceptably high in the United States and significant health disparities exist. The use of telehealth services to deliver maternal care is a possible strategy towards improving delivery of maternity care, increasing patient satisfaction, and reducing health disparities.

Researchers from Oregon Health & Science University conducted a rapid review of 28 RCTs and 14 observational studies of 44,894 women to determine the effectiveness and harms of telehealth strategies for maternal health care in response to the recent expansion of telehealth arising from the COVID-19 pandemic and produced an evidence map to display research gaps. Many of the telehealth strategies included in the review were studied to treat postpartum depression, monitor diabetes or hypertension during pregnancy, or as an alternative to general maternity care for low-risk pregnancies. The authors found that telehealth strategies resulted in mostly similar, or sometimes better, maternal clinical, obstetric, or patient-reported outcomes compared with in-person care. More specifically, they noted that telehealth may have a role as a supplement to usual care for postpartum depression, as telehealth interventions were more likely to improve mood symptoms in the short term compared to in-person care alone, although effects may not be sustained. According to the authors, maternity care is particularly ripe for innovation, given the limited evidence supporting traditional approaches to prenatal care that rely on multiple in-person visits. They add that their findings highlight an ongoing need to incorporate methods to evaluate and improve health equity, an important element lacking in these telehealth studies.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Amy G. Cantor, MD, MPH, please contact please contact the OHSU newsroom at news@ohsu.edu.

------------------------------------------------

Annals of Internal Medicine

Literature review

People

Ethical Considerations in Precision Medicine and Genetic Testing in Internal Medicine Practice: A Position Paper From the American College of Physicians

26-Jul-2022

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

Original post:
ACP offers guidance on the ethical use of genetic testing and precision medicine - EurekAlert